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Triplets : Overview

Multiple birth - triplets or more

If you're 
pregnant with triplets or more, the birth will need careful planning. The main risk with carrying multiples is that they will be born prematurely. Your medical team will assist you decide where and when your babies are going to be born.


Planning for your multiple birth

To plan the birth of triplets or more, your medical team will weigh the risks of premature birth against the risks to both you and your babies of continuous 
the pregnancy.

Generally, the longer your babies can stay in your uterus, the better. But when you are pregnant with triplets or more, complications often develop that mean it’s better for you and your babies if they are born early.

A normal pregnancy lasts 40 weeks. The average length of a pregnancy for triplets is 32 weeks and for quadruplets 30 weeks. Continuing a pregnancy with triplets or more for longer than 36 weeks can be risky both for you and the babies, so it’s usually considered best to deliver them early.

When deciding when and the way 
the babies should change state , your medical team will consider:


Ø  the position of each baby

Ø  the weight of each baby

Ø  your health

Ø  the babies’ health

A caesarean section is usually considered safest when there are 3 or more babies. (Giving birth to triplets or more vaginally is extremely 
rare and not recommended due to the upper risk of labour complications and infant death rate .)

Since almost all triplets or more will be born prematurely, they will need special care - for example, in a neonatal intensive care unit. It is important that the birth is planned in a hospital that has all the facilities that both you and the babies will need.


Multiple birth and preterm labour

In about 3 out of 4 cases, women who are pregnant with triplets will enter 
labour naturally before 35 weeks. The signs and symptoms are the same as with normal labour, including:


Ø     Contractions

Ø     sudden breaking of the waters

Ø     a ‘show’ (when the plug of mucus that has sealed the cervix during pregnancy comes away and out of the vagina)

Contact your medical team immediately if you have any signs of preterm labour. It may be possible to slow down or stop the labour. You will most likely be admitted to hospital and may receive injections of corticosteroids to help the babies’ lungs function better and prevent other complications.


Caesarean section

A caesarean section is usually the safest option when you are carrying 3 or more babies. This is because of the position of the babies, the position of the placenta (or placentas), the risk that a placenta or umbilical cord can be compressed during a vaginal birth, and therefore the 
risk that the babies can become entangled during a childbirth.

If you are carrying triplets or more, you will usually be offered a planned caesarean. You will be given a course of corticosteroids first. If you go into labour spontaneously, you will likely be given a caesarean after you arrive at hospital.

During the operation, you will be given an anaesthetic so you don’t feel any pain. There will be a full medical team in the room, including a specialist obstetrician and paediatrician who are experienced in the care of triplets or more.


Extra care for multiple babies

Babies born before 34 weeks may have 
help with breathing, feeding and keeping warm. They are at greater risk of complications than babies born at full term.

The neonatal intensive care unit has specialist medical staff and equipment to care for premature and sick newborn babies. When your babies not 
need this high level of care, they'll be transferred to the special care nursery or special care baby unit.


Prevention of Multiple baby

Prevention during infertility treatment is that the 
best approach to avoiding a multiple pregnancy. In ART cycles, limiting the number of embryos transferred is an effective approach. Consult the ASRM Practice Committee Report titled Guidelines on Number of Embryos Transferred for recommendations regarding the optimal number of embryos to transfer supported patient age, embryo quality, and other criteria.

The ultimate goal of ART is to realize 
a high pregnancy rate while transferring one embryo. While physicians can transfer two embryos and still maintain acceptable pregnancy rates, the transfer of 1 embryo is related to good pregnancy rates in certain patient groups, thereby resolving the problem of multiple pregnancies caused by multiple embryo transfer. Approximately 10% of embryo transfers in the United States are now performed using elective single embryo transfer.

Multiple pregnancies are a known complication of ovulation stimulation drugs. Most physicians monitor patients with ultrasound examinations and blood tests. A woman with an outsized 
number of ovarian follicles or high hormone levels has an increased risk of a multiple pregnancy, and therefore the cycle could also be canceled to avoid the danger . No proven way of reducing multiple pregnancies with superovulation has been identified, although preventing fertilization with development of quite three follicles is useful in reducing high-order multiples.


Multifetal Pregnancy Reduction

When a triplet or high-order multiple pregnancy occurs, multifetal pregnancy reduction could also be 
considered to enhance the prospect for survival of the fetuses. While multifetal pregnancy reduction carries some risk of an entire miscarriage, it also reduces the probabilities of utmost premature birth. For more information, see the ASRM Patient Fact Sheet Challenges of Parenting Multiples.



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